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Catheter-directed computed tomography angiography: A pictorial essay
How to cite this article: Ghosh A, Moxley E, Waghmarae S, Stoner J, Anand S, Akhter NM. Catheter-directed computed tomography angiography: A pictorial essay. J Clin Imaging Sci 2022;12:49.
Catheter-directed computed tomography angiography (CDCTA) is an imaging technique where CT images are acquired after selective catheterization of a vessel. Images obtained in this fashion provide several advantages over conventional imaging techniques such as fluoroscopic angiography, digital subtraction angiography, cone-beam CT, and conventional CT angiography. At this point, there is still limited literature on the subject, with prior studies examining a small number of potential uses. The goal of this pictorial essay is to illustrate our single tertiary care center experience using CDCTA.
Computed tomography angiography
Catheter-directed computed tomography angiography
Catheter-directed computed tomography angiography (CDCTA) is an imaging technique where CT angiographic images are acquired after selective vessel catheterization. Images obtained in this fashion confer several advantages over conventional imaging techniques, as it provides the regional high-density contrast seen with fluoroscopic angiography and digital subtraction angiography, along with the high spatial resolution and field of view of conventional CT angiography (CTA). As hybrid fluoroscopic/CTA suites are becoming more common, CDCTA may play a larger role in the future.
At present, limited literature exists on this subject, with prior studies only examining a small number of potential uses. CDCTA has been explored in reducing contrast burden in patients at risk for contrast-induced nephropathy in cases of peripheral vascular disease and abdominal aortic aneurysm treatment work-up.[1,2] These studies utilized decreased contrast over conventional CTA, but more importantly described comparable diagnostic image quality. Other studies have demonstrated utility in vessel mapping and targeting of hepatic tumors for radioembolization.[2,3]
Overall, CDCTA can be of benefit in numerous other clinical scenarios, and although it is likely used more commonly than the current literature would suggest, these cases have not been reported.
MATERIAL AND METHODS
A single-center retrospective review of procedures was performed from March 1, 2019, to December 31, 2019, at our institute. Images were obtained using a Canon Infinix-i 4DCT Aquilion PRIME/ONE VISION scanner (Canon Medical Systems, Tustin, CA, US). We identified a total of 20 cases during this period where CDCTA was used; five were selected for presentation. Omnipaque 300 contrast (GE Healthcare Ireland, Cork, Ireland) was diluted 70/30 for all angiographic examinations.
The images below demonstrate how CDCTA, an underrepresented technique, is effective in vessel mapping by providing high contrast sensitivity and spatial resolution compared to other conventional imaging modalities.
CDCTA yields high radiographic contrast density at the tissue level and within small vessels, which promotes correct identification of targeted vessels for treatment. For example, correct recognition of the vessels involved in the Y-90 and UFE cases decreased the risk of non-target embolization and incomplete treatment [Figures 1a-e and 2a-e].
Furthermore, localization in conjunction with high contrast sensitivity is critical in cases of active extravasation. The cases of intercostal hemorrhage and mesenteric hemorrhage described above showcase the utility of CDCTA in correctly identifying and treating target vessels compared to other conventional modalities [Figures 3a-f and 4a-f]. Finally, as the case of portal venous thrombectomy shows, CDCTA provides high spatial resolution of the surrounding structures which enable the operator to see background context before treatment to reassess the plan and adjust treatment as necessary [Figure 5a-e].
The results of this study certainly advocate for the utilization of CDCTA whenever deemed viable as an alternative to traditional fluoroscopic methods. Our internal impression is that CDCTA has the potential to provide greater sensitivity in the detection of active arterial extravasation compared to fluoroscopic angiography and/or conventional CTA. However, a follow-up investigation will certainly be necessary to assess this hypothesis and holistically evaluate these imaging methods head to head in the context of pertinent radiological variables.
CDCTA can serve as a novel and invaluable alternative to traditional imaging modalities in various clinical scenarios.
Declaration of patient consent
Patients’ consent not required as patients’ identity is not disclosed or compromised.
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Conflicts of interest
There are no conflicts of interest.